高尔基体蛋白73和甲胎蛋白联检在原发性肝癌诊断中的临床应用

目的:为了探讨高尔基体蛋白73(Golgi protein73,GP73)和甲胎蛋白(AFP)联检在原发性肝癌(primary hepatic carcinoma,PHC)诊断中的临床应用。方法:采集57例PHC患者、30例良性肝胆疾病患者(胆结石和肝炎)和33例正常对照组血清。酶联免疫吸附试验(ELISA)测定GP73、时间分辨荧光免疫分析(time resolved fluorescent immunoassay,TrFIA)测定AFP。计算GP73和AFP诊断PHC的敏感性、特异性、准确度以及阴、阳性预测值,并应用Logistic回归和ROC曲线对各指标进行分析。结果:57例PHC患者血清GP73和AFP水平均明显高于30例良性肝胆疾病组与33例正常对照组,差异具有统计学意义(P均<0.05)。良性肝胆疾病组血清GP73水平高于正常对照组(P<0.05)。GP73和AFP联检,其敏感性为92.98%、特异性为88.89%、准确度为90.83%;阳、阴性预测值分别为88.33%和90.32%,与单项指标相比差异均有统计学意义(P均<0.05)。GP73、AFP的曲线下面积(area under the ROC cure,AUC)分别为0.900、0.802;两项联检AUC达0.929,>各单项,差异有统计学意义(P<0.05)。结论:血清GP73和AFP是PHC的肿瘤标志物,GP73诊断PHC的价值明显高于AFP。两项联检优于单一的肿瘤标志物,并可提高诊断PHC的正确性。     

磁共振胆胰管成像联合肿瘤标记物CA19-9在胆管癌诊断中的价值

目的探讨磁共振胆胰管成像(MRCP)联合肿瘤标记物CA19-9在胆管癌中的诊断价值.方法回顾性分析26例手术及病理证实为胆管癌和22例胆道良性疾病病人的术前MRCP影像特点,并结合血清肿瘤标记物CA19-9的检测进行评价.结果 MRCP诊断的敏感性为88%,特异性为84%,阳性预测值为85%,阳性似然比为5.5;CA19-9的敏感性为82%,特异性为79%,阳性预测值为84%,阳性似然比为3.9.联合诊断的敏感性为92%,特异性为88%,阳性预测值为96%,阳性似然比为7.7.结论 MRCP联合血清CA19-9的检测,提高了对胆管癌诊断的准确性.     

半乳甘露聚糖抗原检测法对血液患者侵袭性真菌感染早期诊断的价值

目的 评价半乳甘露聚糖抗原检测法对血液肿瘤惠者侵袭性检测真菌感染早期诊断的价值.方法 60例血液肿瘤患者中临床诊断为侵袭性真菌感染及拟诊断为侵袭性真菌感染48例,排除12例.在系统性抗真菌治疗前采集血液标本,采用ELISA试剂盒检测患者血清GM,计算GM试验的灵敏度、特异度、阳性和阴性预测值,观察系统性抗真菌治疗后GM水平的变化.结果 按照试剂盒推荐的分界值(≥0.50ng/ml)时,GM试验诊断的灵敏度为77.5%,特异性为93.9%,阳性预测值为86.7%,阴性预测值为83.6%,按此标准准确定为临床血液肿瘤患者侵袭性真菌感染患者23例,拟诊侵袭性真菌感染患者25例.结论 GM试验对于血液肿瘤患者侵袭性真菌感染早期诊断具有重要的意义,且GM浓度与患者疾病的预后具有相关性.     

13C-UBT和胃镜法诊断胃幽门螺杆菌感染的对比研究

目的对比研究13C-UBT和胃镜法对胃幽门螺杆菌(Helicobacter pylori, Hp)感染的诊断价值.方法分析了204例Hp感染患者均行13C-UBT和胃镜(活检组织切片法)检查.比较两种方法的阳性率及计算13C-UBT的敏感性、特异性、阳性预测值和阴性预测值.结果 13C-UBT阳性率为44.6%,胃镜法的阳性率为42.2%,两者无差异(p＞0.05).13C-UBT的敏感性为98.8%,特异性为94.9%,阳性预测值为93.4%,阴性预测值为99.1%.结论与胃镜法相比,13C-UBT诊断Hp方法简单、安全、无创,具有较高的敏感性和特异性,可作为Hp诊断的首选方法.     

单灶性甲状腺乳头状癌的临床、血清学和超声影像特征及中央区淋巴结转移危险因素分析

目的探究单灶性甲状腺乳头状癌(PTC)的临床、血清学和超声影像特征及中央区淋巴结转移(CLNM)相关的危险因素。方法选择2015年2月至2019年2月收治的246例单灶性PTC患者,其中男性146例,女性100例,年龄32～81岁,平均年龄63.33岁。收集患者的临床、血清学及超声影像特征,根据组织病理学检查结果判断有无CLNM,分析与临床、血清及超声因素间关系。确定影响颈部CLNM的独立危险因素。结果经病理诊断证实,246例患者中有86例(34.96%)发生CLNM,160例(65.04%)未发生CLNM,术前超声诊断CLNM真阳性79例,真阴性143例,假阳性7例,假阴性17例,灵敏度为91.86%,特异度为89.38%,准确率为90.24%。发生CLNM与未发生CLNM的患者在年龄、性别、甲状腺球蛋白(Tg)、术前甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、结节位置、肿瘤最大直径、紧贴被膜、回声上,差异均有统计学意义(P 0.05)。将年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声带入Logistic回归方程计算发现,上述因素比值比(OR)均 1,均是引起单灶性PTC患者发生CLNM的影响因素。结论单灶性PTC患者发生CLNM的危险因素为年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声,临床一旦发现,应考虑行中央区淋巴结清扫。     

纤维乳管镜诊断乳头溢液病变性质与病理学对照分析

目的通过对乳头溢液患者的纤维乳管镜(fiberoptic ductoscopy, FDS)下表现与病理诊断结果作对照分析,探讨FDS在诊断乳头溢液疾病中的临床应用价值。方法对947例病理性乳头溢液患者进行FDS检查,综合分析诊断后与病理结果进行对照分析。结果患者平均年龄43岁,685例占位性病变中良性病变637例(93%),恶性病变48例(7%)。患者年龄35～50岁、肿瘤直径较大、红色溢液的患者中恶性肿瘤比例较高。FDS诊断乳腺导管癌的敏感性为41.7%(20/48),特异性为97.0%(618/637),阴性预测值为95.7%(618/646),阳性预测值为51.3%(20/39),准确性为93.1%(638/685),诊断价值较高。结论 FDS对乳头溢液患者的早期良恶性病变的诊断具有重要价值,并且有利于保留乳房皮肤和乳头、乳晕,是乳头溢液患者首选检查方法。     

心电图多模态积分法诊断右心室肥厚的临床价值

目的 通过建立多模态积分法探讨不同积分诊断右心室肥厚的敏感性、特异性、阳性预测值。方法 回顾性分析115例可疑右心室结构异常患者的临床资料。建立右心室肥厚的心电图诊断模态和积分规则,根据积分结果将患者分为A组(积分2分,47例)、B组(积分3分,37例)和C组(积分4分,31例)。比较各组患者心脏磁共振(CMR)结果,并分析各组诊断右心室肥厚的敏感性、特异性、阳性预测值。结果 经CMR证实115例患者中有66例为右心室肥厚。A、B组患者右心室长径、经体表面积标准化测值右心室舒张末期容积(indexed RVEDV)短/小于C组患者(P 0. 05),右心室射血分数(RVEF)优于C组患者(P 0. 05)。各组患者诊断右心室肥厚的敏感性均较低; C组特异性和阳性预测值高于A、B组,B组特异性和阳性预测值高于A组。结论 心电图多模态积分法积分越高,诊断右心室肥厚的特异性、阳性预测值越高,是一种不易误诊的心电图诊断右心室肥厚的便捷方法,但其敏感性较低,需结合其他检查方法综合判断以避免漏诊。     

半乳甘露聚糖抗原检测法对血液患者侵袭性真菌感染早期诊断的价值

目的评价半乳甘露聚糖抗原检测法对血液肿瘤患者侵袭性检测真菌感染早期诊断的价值。方法 60例血液肿瘤患者中临床诊断为侵袭性真菌感染及拟诊断为侵袭性真菌感染48例,排除12例。在系统性抗真菌治疗前采集血液标本,采用ELISA试剂盒检测患者血清GM,计算GM试验的灵敏度、特异度、阳性和阴性预测值,观察系统性抗真菌治疗后GM水平的变化。结果按照试剂盒推荐的分界值（≥0.50ng/ml）时,GM试验诊断的灵敏度为77.5%,特异性为93.9%,阳性预测值为86.7%,阴性预测值为83.6%,按此标准准确定为临床血液肿瘤患者侵袭性真菌感染患者23例,拟诊侵袭性真菌感染患者25例。结论 GM试验对于血液肿瘤患者侵袭性真菌感染早期诊断具有重要的意义,且GM浓度与患者疾病的预后具有相关性。     

(1,3)-β-D葡聚糖、半乳甘露聚糖联合降钙素原检测对侵袭性真菌感染的诊断价值

目的 探讨血清中(1,3)-β-D葡聚糖[ (1,3) β-D-glucan,G]和半乳甘露聚糖(galactomannan,GM)联合降钙素原(procalcitonin,PCT)检测对患者侵袭性真菌感染(invasive fungal infections,IFI)的临床诊断价值。方法 选取徐州市中心医院2017年1月至2018年6月收治的具有高危IFI因素的住院患者447例,根据血培养结果分成实验室诊断组和非实验室诊断组。分别采用定量检测、比色法及电化学发光法对血清中G、GM和PCT的含量进行检测,评价三者联合检测对IFI的早期诊断价值。结果 447例患者中实验室诊断组51例,非实验室诊断组396例。51例患者中G试验阳性39例,GM试验阳性14例,PCT阳性41例。G试验、GM试验、PCT检测的敏感性为76.47%、27.45%和80.39%;特异性为76.77%、87.12%和66.67%;阳性预测值为29.77%、21.54%和23.70%;阴性预测值为96.20%、90.31%和96.35%;阳性似然比为3.29、2.13和2.41;阴性似然比为0.31、0.83和0.29;Youden指数为0.53、0.15、0.47。三者联合检测的敏感性为94.12%、特异性为62.88%、阳性预测值为24.62%,阴性预测值为98.81%,阳性似然比为2.54,阴性似然比为0.09,Youden指数为0.57。三者联合检测的敏感性均高于G试验、GM试验、PCT单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为6.331、47.545、4.320和5.299,P值均<0.05)。三者联合检测的特异性均低于G试验、GM试验单独检测及G/GM联合试验,差异具有统计学意义(χ2值分别为18.127、62.061和16.754,P值均<0.05),但与PCT单独检测相比差异无统计学意义(χ2=1.245,P>0.05)。结论 G、GM以及PCT三者联合检测可显著提高IFI检出的敏感性,并且对IFI的诊断排除有很大的价值,从而降低假阳性率和假阴性率,为IFI的早期诊断提供一定的依据。     

血小板淋巴细胞比值和肿瘤直径与肝细胞癌微血管侵犯的相关性

目的研究血小板淋巴细胞比值和肿瘤直径与肝细胞癌微血管侵犯的相关性。方法选取2015年10月到2017年2月于新疆生产建设兵团医院就诊的120例肝细胞癌患者,所有患者均行常规肝细胞癌手术切除,术后对患者切除组织进行病理检查,观察患者微血管侵犯情况,并依此分为侵犯组和未侵犯组;记录两组患者一般临床资料,记录肿瘤直径、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、TNM分期、甲胎蛋白(AFP)等。采用单因素和多因素分析肝细胞癌微血管侵犯的影响因素,绘制ROC曲线分析不同指标预测肝细胞癌微血管侵犯的诊断效能。结果病理学检测结果显示,86例患者存在微血管侵犯,34例未侵犯。侵犯组患者肿瘤直径、AFP、PLR、NLR、TNM分期均显著高于未侵犯组(P<0.05);多因素Logistic回归分析显示,肿瘤直径和PLR均为影响肝细胞癌微血管侵犯的危险因素;ROC曲线分析显示,应用PLR和肿瘤直径诊断肝细胞癌微血管侵犯的曲线下面积(AUC)分别为0.755、0.844,对比差异无统计学意义(P>0.05);PLR和肿瘤直径联合诊断的AUC为0.919,明显高于PLR单独诊断(Z=3.635,P<0.001)和肿瘤直径单独诊断(Z=2.541,P=0.011);Youden指数提示PLR和肿瘤直径预测肝细胞癌微血管侵犯情况的最佳截点分别为≥140.67、≥5.35cm,PLR和肿瘤直径联合诊断的灵敏度为95.35%,显著高于各项指标单独诊断(P=0.013、0.013)。结论血小板淋巴细胞比值和肿瘤直径与肝细胞癌微血管侵犯具有明显的相关性,能够作为预测肝细胞癌微血管侵犯的有效指标。     

Intraoperative evaluation of sentinel lymph nodes in breast carcinoma by imprint cytology,frozen section and rapid immunohistochemistry

Sentinel lymph nodes (SLN) isolated in 40 patients of breast carcinoma (stage T₁/T₂) were evaluated intraoperatively by imprint cytology and frozen section. Rapid immunohistochemistry (IHC) was done in cases where both imprint smears and frozen sections were negative for any metastatic tumor deposits. The results of these different techniques were compared with postoperative paraffin sections taken as “Gold Standard.” Nottingham modification of Bloom Richardson scoring system was used for grading the tumors. Further, the correlation of the SLN status with tumor size, grade, and lymphovascular invasion was studied. The sensitivity, specificity, and overall accuracy of imprint cytology were 91.7, 100, and 95% respectively, and those of the frozen section were 95.8, 100, and 97.5% respectively. Examination of multiple serial sections improved the sensitivity and overall accuracy of frozen section. Results of intraoperative rapid IHC were equivalent to final paraffin sections. Histological grade and lymphovascular invasion were in direct correlation with SLN metastasis (P < 0.05). The risk of lymphovascular invasion increased from 22.2% in grade I tumors to 85.7% in grade III tumors. SLN biopsy is a reliable method to evaluate the status of the axillary lymph nodes. Imprint cytology can be used reliably where the facility of frozen section is not available. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Automated immunohistochemical estrogen receptor in fixed embedded breast carcinomas. Comparison with manual immunohistochemistry on frozen tissues

Estrogen receptor (ER) status of breast carcinomas determines prognosis and treatment. Biochemical ER assays are expensive and time-consuming and require fresh tumor. Immunohistochemical ER was assessed in 68 breast carcinomas, by an automated method using routinely processed formalin-fixed paraffin-embedded tissues, and manually with the use of snap-frozen tissues with a monoclonal anti-ER and peroxidase-antiperoxidase technique. The paraffin sections were digested with DNase to enhance development of signal. Positive nuclear ER was obtained in 9 (13%) fixed tissues and 36 (53%) frozen tissues. The sensitivity, specificity, and predictive value of a positive test result, as compared with the biochemical assay, were 25%, 100%, and 100% for the paraffin section technique, and 89%, 88%, and 89% for the frozen sections. Although it is specific, lack of sensitivity, resulting from loss of ER with fixation and room temperature handling, renders this immunohistochemical technique unacceptable on fixed tissues. However, ER immunostain on frozen tissue is an acceptable alternative to biochemical assay.     

Cytological diagnosis of breast tumours by the imprint method

Tumour imprints were made from 311 breast tumours at the time of frozen section. Rapid and permanent staining methods were employed and the accuracy of diagnosis was compared with that obtained from frozen and paraffin sections. Two false positives (0·65%) and 16 false negatives (5·15%) were found in the imprint group compared with no false positives and five false negatives (1·6%) in the frozen section group.     

Frozen section diagnosis in donor liver biopsies: observer variation of semiquantitative and quantitative steatosis assessment

Donor livers are not generally accepted for liver transplantation if intraoperative frozen section histology on wedge biopsies provides evidence for more severe steatosis. In this reliability study, assessment of steatosis in donor liver biopsies by different approaches (frozen sections vs. paraffin sections; macrovesicular steatosis vs. microvesicular steatosis), different observers, and different evaluation methods (conventional microscopy vs. point grid analysis on digital microphotographs) was compared. One hundred twenty consecutive donor liver biopsies were investigated. Intraoperative diagnosis was made on hematoxylin and eosin (H&E)-stained frozen sections. The residual portion of each biopsy was analyzed later on H&E-, diastase-resistant PAS-, and Elastica van Gieson-stained paraffin sections. Microvesicular steatosis and macrovesicular steatosis were classified semiquantitatively into 5?% steps. Additionally, point grid counting was applied on ten digital microphotographs per slide. The values for steatosis revealed a wide range of data between 0 and 70 or 85?% (mean values, 12.0-18.3?%), considering all types of specimens. The results of the two observers were highly correlated for macrovesicular steatosis (r?≥?0.925) and for microvesicular steatosis (r?≥?0.880). The values for macrovesicular and microvesicular steatosis, however, showed poor correlation (r?≤?0.581). The rate of agreement between the two observers ranged between 84.2 and 95.8?% (κ, 0.763-0.937), depending on the threshold setting. For point grid analysis, significantly lower mean values and ranges for both types of steatosis compared to conventional histopathology were found (p?相似文献   

Touch preparations in the rapid intraoperative diagnosis of central nervous system lesions. A comparison with frozen sections and paraffin-embedded sections

Cytologic preparations provide a rapid, simple method for intraoperative diagnosis of central nervous system (CNS) lesions. Details of cellular morphology are defined sharply, avoiding artifacts often introduced by the frozen section technique. In 100 neurosurgical biopsies performed between 1984 and 1986, touch preparations and cryostat (frozen) sections were made at the time of surgery for preliminary intraoperative diagnosis. To assess the accuracy of each of the diagnostic methods used independently, slides obtained with each of the two techniques were later reviewed retrospectively with appropriate clinical and radiological data, but without knowledge of the final neuropathological diagnoses. When compared with the final diagnoses, intraoperative diagnoses were confirmed in 95 cases. The diagnoses based on cytologic and frozen section techniques were compared with the final diagnoses based on paraffin sections. Touch preparation diagnosis was confirmed by paraffin sections in 76 cases; in 18 additional cases a clinically useful, but nonspecific diagnosis (benign versus malignant, glial versus nonglial) was established by touch preparation. In five cases with firm or rubbery tumors, insufficient cells were imprinted for reliable evaluation, and no definitive diagnoses could be made. Specific cryostat diagnoses were confirmed by paraffin sections in 88 cases; nonspecific diagnoses were made in 11 cases. A single incorrect diagnosis was obtained with each technique. When the two techniques were used together, a specific and accurate diagnosis was achieved in 95 cases. Touch preparations were superior to frozen sections for evaluating soft or highly cellular tumors and for preliminary diagnosis from a minute surgical specimen (i.e., stereotactic biopsy).(ABSTRACT TRUNCATED AT 250 WORDS)     

Reassessment of the usefulness of frozen section analysis for hip and knee joint revisions

Intraoperative frozen section (FS) consultation is used in evaluating possible infection in cases of hip and knee revision arthroplasty, serving as an adjunct to preoperative and intraoperative studies. We examined our experience for more than 11 years to determine if FS examination had value when sections were sent nonselectively. We reviewed 244 cases, 132 with available culture results. The criterion for the presence of acute inflammation was more than 5 polymorphonuclear leukocytes per high-power field (hpf) in at least 5 separate hpfs, excluding surface inflammatory exudate and fibrin. Only 27 cases (11.1%) demonstrated positive FS or paraffin section results. In comparison with intraoperative culture, the sensitivity, specificity, positive predictive value, and negative predictive value for FS analysis alone (on review) were 29%, 95%, 40%, and 92%. As currently used, FS analysis has excellent specificity and negative predictive value but poor sensitivity and positive predictive value. We suggest that FS examination be used more selectively in conjunction with other studies, namely erythrocyte sedimentation rate and C-reactive protein.     

Interinstitutional comparison of frozen section consultation in small hospitals: a College of American Pathologists Q-Probes study of 18,532 frozen section consultation diagnoses in 233 small hospitals

OBJECTIVE: To study pathology intraoperative consultation practices and the accuracy of diagnoses made by frozen section. DESIGN: In 1994, participants in the College of American Pathologists Q-Probes laboratory quality improvement program each completed questionnaires and prospectively collected data on up to 20 frozen section procedures performed over a 5-month period. SETTING: Surgical pathology laboratories serving private and public hospitals with 300 or fewer occupied beds. PARTICIPANTS: Two hundred thirty-two North American institutions and one New Zealand institution. MAIN OUTCOME MEASURES: The discordance and deferral rates of frozen section diagnoses and the reasons for frozen section discordance relative to corresponding diagnoses made on permanent (paraffin) sections. Calculation of frozen section discordance rates excluded diagnoses of subtypes or grade of malignancy, biopsies on specimens in which there was no gross lesion (eg, mammographic specimens), thyroid follicular lesions, tissue taken only to determine adequacy for other studies (eg, estrogen-binding proteins), and frozen sections performed to evaluate margins of specimens oriented en face. RESULTS: Out of 18,532 frozen section diagnoses performed on 327,884 surgical cases, 859 (4.6%) diagnoses were deferred until permanent sections were available for review; 17,357 (98.2%) nondeferred diagnoses agreed with, and 316 (1.8%) disagreed with, those diagnoses rendered on permanent sections. The most common cause of discordance was underdiagnosis of neoplasia, usually due to block- or tissue-sampling errors. CONCLUSIONS: We recommend that laboratories routinely monitor frozen section discordance, cut additional sections deeper into the frozen block and/or sample additional tissue when the initial frozen section diagnosis is negative or nonproductive, reconcile all discordant frozen section diagnoses in the final report, and periodically assess the value of performing frozen section examinations.     

Frozen section diagnosis: an audit.

A consecutive series of 1000 operative frozen section diagnoses was reviewed. Correct diagnosis was made at the time in 96.5% of the cases. Clinically relevant errors were found in 1.3% of the cases and unimportant errors in 0.9%. Diagnosis was deferred, to await subsequent paraffin sections, in a further 1.3%. All the errors and provisional diagnoses in the deferred cases were conservative false negative results; no false positive diagnosis of malignancy was made. The cases of incorrect or deferred diagnosis were analysed to ascertain the origin of the difficulties, which comprised: technical imperfection (three cases); the focal nature of the lesion (14); and pathological misinterpretation (28). More than one of these factors played a part in eight cases. Further retrospective assessment indicated that the factors leading to error or deferred diagnosis were avoidable in 57% and potentially avoidable in 43% of cases. Misinterpretation was the single factor responsible for all avoidable misdiagnoses or deferred diagnosis. None the less, unavoidable factors led to erroneous or deferred diagnosis in about 2% of operative frozen section requests. Using present methods this seems to be the irreducible minimum of failures to make the correct diagnosis when frozen sections are assessed.     

Frozen section diagnosis of hypertensive pulmonary vascular changes at surgery for congenital heart anomalies

Frozen sections of lung biopsy were prepared in 30 cases of congenital heart anomalies with pulmonary hypertension, and evaluation of severity of the pulmonary vascular changes was made during the surgery. Statistically, significant differences was not found between the diagnosis made by frozen sections and those made by paraffin sections. It is concluded that rapid and accurate diagnosis of pulmonary vascular changes can be made by means of frozen section diagnosis. This method will prove to be clinically important by assisting during operation in rapid assessment of indication for total correction of congenital heart anomalies.     

Intraoperative frozen section examination of axillary sentinel lymph nodes in breast cancer

The study presents the results from intraoperative frozen section assessment of axillary sentinel lymph nodes (SLNs) in breast cancer. Routine histological frozen sections from one level were used, two sections stained with haematoxylin and eosin. Immunohistochemistry for cytokeratins was applied to the permanent SLN paraffin sections only. Axillary dissection was performed on all SLN-positive cases regardless of the size of the metastatic deposits. With a detection rate of 83%, 272 patients entered the study over a period of 46 months. A total of 61 cases were SLN positive by frozen section analysis. The paraffin sections gave an additional 23 SLN-positive cases. The false-negative rate for frozen sections was then 27% (23/84). Micrometastases were found in 28 of 84 cases, and macrometastases in 56. The false-negative rate of frozen sections for micrometastases was 71% (20/28), and for macrometastases 5% (3/56). A total of 73% (61/84) of the patients underwent axillary surgery as a one-step procedure.